GW1-2022-03772_Well Construction - GW1_20220404

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water QualityA
WELL CONTRACTOR CERTIFICATION#3073
I
1.WELL CONTRACTOR: g. WATER ZONES(depth):
Rick Crane Top Bottom Top Bottom
Well Contractor(Individual)Name Top Bottom Top Bottom
Crane Bros. Well Drillina Top Bottom Top Bottom
Well Contractor Company Name Thickness/
248 Crane Circle 7. CASING: Depth Diameter Weight Material
Street Address TopO Bottom60 �Ft.61/4 SDR-2 PVC
Franklin NC 28734 Top Bottom Ft.
City or Town State Zip Code Top Bottom Ft._
I
l 828 ) 524-4976
Area code Phone number 8. GROUT: Depth Material Method
2.WELL INFORMATION: TopO Bottom20 'Ft.benonite pumped
WELL CONSTRUCTION PERMIT#1 10421-D Top Bottom Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID#(if applicable)6577743953 9. SCREEN: Depth i' Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply 11 Top Bottom Ft. in. in.
DATE DRILLED 03/02/2022 Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
TIME COMPLETED AM❑ PM&0
4.WELL LOCATION: : 10.SAND/GRAVEL PACK:
CITY: Franklin COUNTYMacon Depth Size Material
Top Bottom Ft.
Rose Creek Top Bottom Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) Top Bottom Ft.
TOPOGRAPHIC/LAND SETTING: (check appropriate box)
❑Slope ❑Valley []Flat ❑Ridge []Other11.DRILLING LOG
Top Bottom Formation Description
LATITUDE 35 14 14.9990 ^DMS OR 3x.XXXXXXXXX DD 0 /60 Clav
LONGITUDE 83 M°25 -5M•000 "DMS OR 7x.XXXXXXXXx DD 60 /955 granite
Latitude/longitude source: FPS Qropographic map
(location of well must be shown on a USGS topo map andattached to l
this form if not.using GPS) l
6.WELL OWNER /
Charles Greb j -
Owner Name
Rose Creek. I APR -
Street Address /
Franklin NC 28734 / ; %
City or Town State Zip Code / r
U
Area code Phone number
12. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH:955
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO le
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: 100 FT. ACCORDANCE WITH 15AINCAC 2C,WELL CONSTRUCTION
(Use"+"If Above Top of Casing) STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN
PRO ED TO THE WEL OWNER.
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d. TOP OF CASING IS FT.Above Land Surface`
`Top of casing terminated attor below land surface may require 03/30/22
a variance in accordance with 15A NCAC 2C.0118. S G ATURE OF CERTIFIED W ELL CONTRACTOR DATE
e. YIELD(gpm):2 METHOD OF TESTAir Rick Crane
f. DISINFECTION:Type Amount PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit wtthiln 30 days of=completion to Division of-Water Quality Information Pracesstng, ; Form GWAa
€ 1617 Mail Service Certer,Raleigh,=NC 271i99 1 t1,.Phone '(919)_807-6300 Rev.2/09